Healthcare Reform and the Fear Factor

John McClaughry's column "Vermont's coming all payer 'reform'" (09/30/2015) raises an awful lot of fears in its roughly 750 words. One thing it does not do is mention that since 1971 Maryland has been operating a version of the all payer system that applies to hospital care. Between 1976 and 2007, Maryland had the second lowest rate of increase in costs per hospital admission in the country.

A few other points from Mr. McClaughry's column need to be addressed. He says that Vermont wants to "get its hands on the flow of Medicare funds." People should know that all payer systems tend to raise the amounts that doctors and hospitals receive for providing services to Medicare recipients. That tends to make more providers willing to take Medicare patients.Mr. McClaughry points to what he perceives as the evils of Quebec's healthcare system, including "allowing non-doctors to perform more services." Yet in his online comment to the Vermont Digger article that spurred Mr. McClaughry's column, he approvingly cites a book that favors innovations like the company (MinuteClinic) that provides low cost basic healthcare in retail stores largely by using nurse practitioners rather than doctors (the book is "The Innovator's Prescription: A Disruptive Solution for Health Care").

None of which is to say that the proposed move to the all payer system is really a solution to the problems of healthcare in Vermont and the nation as a whole. All payer addresses how much providers can charge for a service; it does not by itself ensure that the people who need care can afford that payment. It is not the same as universal care.

In any case, the system we have now is simply not sustainable. As retired doctors Michael Huntington and Bruce Thomson recently said in a column elsewhere, insurance companies "can and do bar us from care through unaffordable deductibles, denied/delayed claims, narrow drug panels, narrow drug formularies, hidden exclusions and by driving doctors to despair and early retirement."